WO2019169779A1 - 一种无需血管扩张剂测量血流储备分数的方法 - Google Patents

一种无需血管扩张剂测量血流储备分数的方法 Download PDF

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WO2019169779A1
WO2019169779A1 PCT/CN2018/091166 CN2018091166W WO2019169779A1 WO 2019169779 A1 WO2019169779 A1 WO 2019169779A1 CN 2018091166 W CN2018091166 W CN 2018091166W WO 2019169779 A1 WO2019169779 A1 WO 2019169779A1
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blood
pressure
coronary
blood flow
dimensional
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PCT/CN2018/091166
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English (en)
French (fr)
Chinese (zh)
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霍云飞
刘广志
王之元
张海玲
霍勇
龚艳君
李建平
易铁慈
杨帆
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苏州润迈德医疗科技有限公司
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Priority to EP18908596.2A priority Critical patent/EP3763285A4/en
Priority to JP2020542074A priority patent/JP6976011B2/ja
Publication of WO2019169779A1 publication Critical patent/WO2019169779A1/zh

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/103—Detecting, measuring or recording devices for testing the shape, pattern, colour, size or movement of the body or parts thereof, for diagnostic purposes
    • A61B5/107—Measuring physical dimensions, e.g. size of the entire body or parts thereof
    • A61B5/1073—Measuring volume, e.g. of limbs
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
    • A61B5/021—Measuring pressure in heart or blood vessels
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
    • A61B5/021—Measuring pressure in heart or blood vessels
    • A61B5/0215—Measuring pressure in heart or blood vessels by means inserted into the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
    • A61B5/024—Detecting, measuring or recording pulse rate or heart rate
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
    • A61B5/026—Measuring blood flow
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
    • A61B5/026—Measuring blood flow
    • A61B5/0295—Measuring blood flow using plethysmography, i.e. measuring the variations in the volume of a body part as modified by the circulation of blood therethrough, e.g. impedance plethysmography
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/103—Detecting, measuring or recording devices for testing the shape, pattern, colour, size or movement of the body or parts thereof, for diagnostic purposes
    • A61B5/107—Measuring physical dimensions, e.g. size of the entire body or parts thereof
    • A61B5/1076—Measuring physical dimensions, e.g. size of the entire body or parts thereof for measuring dimensions inside body cavities, e.g. using catheters
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B2576/00—Medical imaging apparatus involving image processing or analysis
    • A61B2576/02—Medical imaging apparatus involving image processing or analysis specially adapted for a particular organ or body part
    • A61B2576/023—Medical imaging apparatus involving image processing or analysis specially adapted for a particular organ or body part for the heart

Definitions

  • the invention belongs to the field of coronary artery imaging, and in particular relates to a method for measuring blood flow reserve fraction without using a vasodilator.
  • the blood flow reserve fraction can indicate the influence of coronary stenosis on distal blood flow and the diagnosis of myocardial ischemia, which has become a recognized indicator of functional evaluation of coronary stenosis.
  • Methods for calculating blood flow reserve fraction (FFR) of existing methods include:
  • Method 1 The pressure guide wire measures the pressure Pd at the distal end of the coronary stenosis in the maximum hyperemia state of the myocardium to calculate the FFR;
  • Method 2 The published patent "Computation method of coronary blood flow reserve fraction based on X-ray coronary angiography image” obtains three-dimensional morphology of blood vessels by coronary angiography image, calculates blood flow, and calculates the distal pressure Pd of coronary stenosis by hydrodynamic simulation. Calculate FFR.
  • the above two methods are based on the blood flow velocity under the maximum hyperemia of the myocardium and the mean aortic pressure (Pa) of the coronary artery.
  • the FFR is calculated by different means to obtain the mean intrapulmonary pressure (Pd) of the stenotic distal coronary artery.
  • maximal hyperemia of the myocardium requires intra- or intra-arterial injection of adenosine or ATP. Injection of adenosine or ATP may cause aortic pressure drop and have certain side effects such as atrioventricular block, sinus sinus, sinus stop, etc., contraindications. Including 2 or 3 degrees of atrioventricular block to block, sinus node disease, tracheal or bronchial asthma, allergic to adenosine.
  • the object of the present invention is to provide a method for measuring blood flow reserve fraction without using a vasodilator, and to detect myocardial ischemia by conventional coronary angiography in patients with coronary heart disease, that is, without using a vasodilator (ie, without the maximum hyperemia of the myocardium and
  • the blood flow reserve fraction was calculated by conventional angiography, aortic pressure, and blood flow without adenosine or ATP. It was named coronary angiography Fractional Flow Reserve (CAFFR, the following texts are abbreviations) .
  • the technical solution of the present invention is: a method for measuring a blood flow reserve fraction without using a vasodilator, characterized in that the method comprises the following steps:
  • Step S1 measuring the pressure P1 of the coronary artery through the blood pressure sensor
  • Step S2 obtaining a two-dimensional diameter and length of the blood vessel by using the contrast image, and generating a three-dimensional blood vessel mesh model by using two contrast images with an angle of 30° or more and obtaining a three-dimensional diameter and length of the blood vessel;
  • Step S3 measuring the time taken by the blood from the starting point to the ending point of the blood vessel, and calculating the blood flow velocity V1 according to the time and the three-dimensional length of the blood vessel;
  • Step S4 calculating the aortic pressure P2 in the maximum hyperemia state
  • Step S5 calculating the blood flow velocity V2 in the maximum congestion state
  • V2 1.65*V1+60;
  • V2 1.23 * V1 + 100;
  • V2 0.95*V1+150;
  • Step S6 using the blood flow velocity V2 in the maximum hyperemic state calculated in step S5 as the coronary inlet flow velocity, and using the aortic pressure P2 in the maximum hyperemia state calculated in step S4 as the coronary inlet pressure Pa, and calculating the coronary artery.
  • the specific method for measuring the cardiac coronary pressure P1 in step S1 is as follows:
  • the pressure tube of the blood pressure sensor is connected to the multiple tee, and then connected to the coronary artery through the contrast catheter, the pressure tube of the blood pressure sensor is filled with saline, and the blood pressure sensor is kept at the same level as the heart, and the blood pressure sensor measures The pressure value is the pressure P1 of the coronary artery.
  • step S2 the specific method of the three-dimensional vascular grid model in step S2 is as follows:
  • the 2D structural data of the two-segment blood vessels on the two different angles of the X-ray coronary angiography image are mapped in three dimensions, and the 3D structural data of the segmented blood vessels is obtained;
  • the specific method for calculating the blood flow velocity V1 in step S3 is as follows:
  • the start and end points of a cardiac cycle are respectively obtained on the images corresponding to the two-dimensional start frame and the end frame, and then the start point and the end point are in the three-dimensional synthesized data. Intercepting the length of a blood vessel in a cardiac cycle;
  • the specific method for calculating the pressure drop ⁇ P from the coronary portal to the distal end of the coronary stenosis in step S6 is as follows:
  • P, ⁇ , ⁇ are flow velocity, pressure, blood flow density, blood flow viscosity, respectively;
  • the inlet boundary condition is the blood flow velocity
  • the exit boundary condition is the out-flow boundary condition
  • the pressure drop ⁇ P from the inlet to the downstream points along the centerline of the vessel is calculated.
  • the present invention is directed to detecting myocardial ischemia by conventional coronary angiography in patients with coronary heart disease, that is, without using a vasodilator (ie, without maximal hyperemia of the myocardium and without using adenosine or ATP), conventional contrast images, aortic pressure, and Blood flow computed to calculate coronary flow reserve fraction (CAFFR).
  • a vasodilator ie, without maximal hyperemia of the myocardium and without using adenosine or ATP
  • conventional contrast images ie, without maximal hyperemia of the myocardium and without using adenosine or ATP
  • contrast images ie, without maximal hyperemia of the myocardium and without using adenosine or ATP
  • aortic pressure ie, without maximal hyperemia of the myocardium and without using adenosine or ATP
  • CAFFR Blood flow computed to calculate coronary flow reserve fraction
  • Figure 1 is a comparative distribution of aortic pressure data measured at rest in the aorta and maximal hyperemia
  • Figure 2 is a comparative plot of measured blood flow velocity at rest and blood flow velocity data at maximum hyperemia.
  • Figure 3 is a graphical representation of the correlation and consistency of CAFFR and FFR.
  • Step S1 The pressure P1 of the coronary artery is measured by a blood pressure sensor, and the specific method is as follows:
  • the pressure tube of the blood pressure sensor is connected to the multiple tee, and then connected to the coronary artery through the contrast catheter, the pressure tube of the blood pressure sensor is filled with saline, and the blood pressure sensor is kept at the same level as the heart, and the blood pressure sensor measures The pressure value is the pressure P1 of the coronary artery;
  • Step S2 obtaining a two-dimensional diameter and length of the blood vessel by using the contrast image, and generating a three-dimensional blood vessel mesh model by using two contrast images with an angle of 30° or more and obtaining a three-dimensional diameter and length of the blood vessel;
  • the two-dimensional structure data of the two segmented blood vessels on the two different angles of the X-ray coronary angiography image are mapped three-dimensionally, and the 3D structural data of the segmented blood vessels is obtained;
  • Step S3 measuring the time taken for the blood to flow from the starting point to the ending point of the blood vessel, and calculating the blood flow velocity V1 according to the time and the three-dimensional length of the blood vessel, the specific method is as follows:
  • the start and end points of a cardiac cycle are respectively obtained on the images corresponding to the two-dimensional start frame and the end frame, and then the start point and the end point are in the three-dimensional synthesized data. Intercepting the length of a blood vessel in a cardiac cycle;
  • Step S4 calculating the aortic pressure P2 in the maximum hyperemia state
  • Figure 1 shows the comparative distribution of aortic pressure data measured under resting state in the aorta and maximal hyperemia.
  • the B line is the aortic pressure at rest
  • the A line is the aortic pressure under the maximum hyperemia state.
  • C Lines and D lines are the aortic pressures in the maximum congested state of each segment.
  • Step S5 calculating the blood flow velocity V2 in the maximum congestion state
  • V2 1.65*V1+60;
  • V2 1.23 * V1 + 100;
  • V2 0.95*V1+150;
  • Fig. 2 is a comparative distribution of blood flow velocity measured under resting state and blood flow velocity data under maximum congestion state, the abscissa is the resting blood flow velocity, and the ordinate is the blood flow velocity under the maximum hyperemia state.
  • Step S6 using the blood flow velocity V2 in the maximum hyperemic state calculated in step S5 as the coronary inlet flow velocity, and using the aortic pressure P2 in the maximum hyperemia state calculated in step S4 as the coronary inlet pressure Pa, and calculating the coronary artery.
  • step S6 The specific method for calculating the pressure drop ⁇ P from the coronary portal to the distal end of the coronary stenosis in step S6 is as follows:
  • P, ⁇ , ⁇ are flow velocity, pressure, blood flow density, blood flow viscosity, respectively;
  • the inlet boundary condition is the blood flow velocity
  • the exit boundary condition is the out-flow boundary condition
  • the pressure drop ⁇ P from the inlet to the downstream points along the centerline of the vessel is calculated.
  • Table 1 compares the calculation results of CAFFR and FFR:
  • CAFFR and FFR have good correlation and consistency.

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PCT/CN2018/091166 2018-03-05 2018-06-13 一种无需血管扩张剂测量血流储备分数的方法 WO2019169779A1 (zh)

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EP18908596.2A EP3763285A4 (en) 2018-03-05 2018-06-13 METHOD FOR CORONARY RESERVE FLOW MEASUREMENT WITHOUT VASODILATOR
JP2020542074A JP6976011B2 (ja) 2018-03-05 2018-06-13 血管拡張剤を必要としない冠血流予備量比を測定する方法

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CN113616176A (zh) * 2019-12-31 2021-11-09 深圳北芯生命科技股份有限公司 具有回撤装置的血管内压力测量系统
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CN111369519A (zh) * 2020-03-02 2020-07-03 博动医学影像科技（上海）有限公司 冠状动脉的血流速度的计算方法、装置及电子设备

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